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标题：Trends in Childhood Leukemia in Basrah, Iraq, 1993–2007
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作者：Amy Hagopian ; Riyadh Lafta ; Jenan Hassan 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：6
页码：1081-1087
DOI：10.2105/AJPH.2009.164236
语种：English
出版社：American Public Health Association
摘要：Objectives. Through a sister-university relationship between the University of Basrah and the University of Washington, we analyzed Ibn Ghazwan Hospital's leukemia registry data to evaluate trends in childhood leukemia since 1993. Methods. We documented leukemia cases among children aged 0 to 14 years for each of the last 15 years. Population data were obtained from a 1997 census and various subsequent estimates to calculate rates. Results. We observed 698 cases of childhood leukemia between 1993 and 2007, ranging between 15 cases (2.6 per 100 000 annual rate) in the first year and 56 cases (6.9 per 100 000 annual rate) in the final year, reaching a peak of 97 cases in 2006 (12.2 per 100 000 annual rate). Conclusions. Childhood leukemia rates in Basrah more than doubled over a 15-year period. The test for trend was significant ( P = .03). Basrah's childhood leukemia rate compared unfavorably with neighboring Kuwait and nearby Oman, as well as the United States, the European Union, and other countries. The hematologic malignancy leukemia is the most common childhood cancer. Incidence rates in higher-income countries range from 4.0 to 4.4 per 100 000 per year, typically higher than in lower-income countries (e.g., 0.9 per 100 000 per year in Vietnam),^{1 , 2} although these disparities may simply reflect the lack of cancer registries in low-income countries.³ The most common type of childhood leukemia is acute lymphoblastic leukemia (ALL), which makes up approximately 80% of leukemia cases, followed by acute myeloid leukemia (AML) and chronic myeloid leukemia (CML), with relatively few in other categories.⁴ Childhood leukemia rates increased in Europe 1.4% per year from 1975 to 1995⁵ while staying largely stable in the United States during this period.⁶ Males typically have higher rates of leukemia than do females.¹ Although the etiology of most childhood leukemias⁷ is unknown, several factors in addition to socioeconomic status⁸ have been associated with the disease, including Hispanic population affiliation,¹ ionizing radiation,⁹ environmental exposures including chemicals and infectious agents,¹⁰ chromosomal abnormalities,¹¹ perinatal influences,¹² birth weight,¹³ and parental exposure factors.^{14 – 17} The variation in incidence between countries is less for childhood leukemia than for adult cancers, which suggests the same or equipotent risk factors for childhood leukemia in different countries.² Basrah is the most southern governorate in Iraq, containing the country's third largest city and its only major port. Its strategic location, on the Shatt al Arab waterway below the confluence of the Tigris and Euphrates rivers and short distances from Iran and Kuwait, has made it a focal point for the last three of Iraq's major wars from 1980 to the present (see map, Figure 1 ). This study was initiated as part of a sister-university relationship between the University of Basrah and the University of Washington following reports by a University of Basrah pediatric oncologist (J. H.) of increasing rates of childhood malignancies in the Basrah oncology referral hospital. University of Washington researchers (A. H., T. T., and S. D.) then engaged an experienced Iraqi epidemiologist (R. L.) to assist in the assessment of the cancer rates in the governorate of Basrah. The purpose of this study was to assess changes in the rates of childhood leukemia in Basrah, Iraq, from 1993 through 2007. Open in a separate window FIGURE 1 Map of Iraq. Source . United Nations Cartographic Section map of Iraq used by permission, no. 3835 Rev. 4 January 2004. Available at: http://www.un.org/Depts/Cartographic/english/htmain.htm . Accessed June 30, 2009.